Request a Quote First Name Last Name Email Phone Number Date of Birth Street Address City Province Postal Code Type Please Select...HomeTenantCondo Building Type Please select...Detached HomeSemi detached HomeTownhouseDuplexTriplex Dwelling Replacement Cost Building Type Please select...Apartment BuildingBasement ApartmentTownhouseDuplexTriplex Number of Stories Content Replacement Cost Distance to Fire Hydrant Distance to Fire Hall Construction Type Please Select...Solid Brick or MasonryWood FrameOther Year Built Primary Heating Source Please Select...GasWoodElectrical Burglar Alarm Please Select...NoneLocalMonitored Fire Alarm Please Select...NoneLocalMonitored Years with Residential Insurance Number of Claims in the Past 10 Years All Members of Household Non-Smokers? Please Select...YesNo In order for insurers to make their best offer, do you authorize them to obtain your credit information from credit agencies? Send Let's Work TogetherGalaxy Insurance Brokers – Your go-to source for tailored commercial & personal insurance solutions that safeguard your future.
